Oral methotrexate and vaginal misoprostol for early abortion

Intramuscular methotrexate followed by vaginal misoprostol has been shown to be effective for abortion at less than or equal to 49 days gestation. Oral dosing of the methotrexate may offer advantages over parenteral dosing. This pilot study was performed to evaluate if oral methotrexate would be effective when combined with vaginal misoprostol to efject abortion at less than or equal to 49 days gestation. Twenty pregnant women were randomized to receive methotrexate 25 mg or 50 mg followed 7 days later by misoprostol 800 mu g vaginally. The misoprostol dose was repeated the next day ii the abortion did not occur. Complete abortion occurred in all subjects in both groups within 20 days alter the methotrexate. However, women in the 50 mg group passed the pregnancy within 24 hours of the first or second dose of methotrexate more often than women in the 25 mg group (80% vs. 50%, p = 0.35). Vaginal bleeding lasted 12.2 +/- 3.1 days and 9.4 +/- 4.5 days in immediate success and delayed success patients, respectively. Oral methotrexate may be an effective alternative to intramuscular methotrexate in treatment regimens for non-surgical abortion.